CASE REPORT
Introdução: Os espasmos hemifaciais são movimentos clônicos dos músculos faciais inervados pelo nervo facial. São unilaterais por definição tradicionalmente tendo como causa a compressão vascular da zona de saída do nervo facial. Poucos casos descritos na literatura abordam cistos neuroentéricos como causa. O presente estudo vem relatar um raro caso de cisto neuroentérico causando essa alteração neurológica. e revisar na literatura sobre essa patologia e suas causas Relato de Caso: mulher de 58 anos com história de 3 anos de espasmos hemifaciais esquerdos. Ela foi investigada com uma ressonância magnética cerebral que mostrou uma lesão cística no ângulo pontocerebelar. Submetemos a paciente à ressecção desta lesão por via retrossigmoide em decúbito dorsal. Os estudos anatomopatológicos nos trouxeram o diagnóstico de cisto neuroentérico, entidade rara do ângulo pontocerebellar. Conclusão: Nosso caso seguiu a revisão narrativa da literatura sobre o tema e a abordagem retrossigmoide em decúbito lateral é suficiente para ressecar uma lesão da fossa posterior comprimindo o nervo facial. Com o maior acesso à investigação com imagens modernas e avançadas, é provável que se encontre um espectro mais amplo de diagnósticos causadores de espasmo hemifacial e o tratamento deve ser sempre direcionado à etiologia.
Introduction: Hemifacial spasms are clonic movements of facial muscles innervated by the facial nerve. They are unilateral by definition, traditionally caused by vascular compression of the exit zone of the facial nerve. Few cases described in the literature address neurenteric cysts as the cause. The present study reports a rare case of neurenteric cyst causing this neurological alteration. and reviews the literature on this pathology and its causes. Case presentation: 58-year-old woman with a 3-year history of left hemifacial spasms. She was investigated with a brain MRI which showed a cystic lesion at the cerebellopontine angle. We submitted the patient to resection of this lesion via the retrosigmoid approach in the supine position. The anatomopathological studies brought us the diagnosis of neurenteric cyst, a rare entity of the cerebellopontine angle Conclusion: Our case followed the narrative review of the literature on the subject and the retrosigmoid approach in lateral decubitus is sufficient to resect a lesion of the posterior fossa compressing the facial nerve. With greater access to investigation with modern and advanced images, it is likely that a broader spectrum of diagnoses causing hemifacial spasm will be found and treatment should always be directed to the etiology.
1. Gálvez-Jiménez N, Hanson MR, Desai M. Unusual causes of hemifacial spasm. Semin Neurol. 2001;21(1):075-084. http://dx.doi. org/10.1055/s-2001-13122.
2. Singh AK, Jain VK, Chhabra DK, Hongo K, Kobayashi S. Hemifacial spasm and cerebellopontine angle epidermoid: case report and review. Neurol Res. 1994;16(4):321-3. http://dx.doi.org/10.1080/01616412.19 94.11740248. PMid:7984265.
3. Oliveira LD, Cardoso F, Vargas AP. Hemifacial spasm and arterial hypertension. Mov Disord. 1999;14(5):832-5. http://dx.doi. org/10.1002/1531-8257(199909)14:5<832::AID-MDS1017>3.0.CO;2-7. PMid:10495046.
4. Loeser JD, Chen J. Hemifacial spasm: treatment by microsurgical facial nerve decompression. Neurosurgery. 1983;13(2):141-6. http:// dx.doi.org/10.1227/00006123-198308000-00006. PMid:6888693.
5. Chaudhry N, Srivastava A, Joshi L. Hemifacial spasm: the past, present and future. J Neurol Sci. 2015;356(1-2):27-31. http://dx.doi. org/10.1016/j.jns.2015.06.032. PMid:26111430.
6. Rudzińska M, Wójcik M, Szczudlik A. Hemifacial spasm non-motor and motorrelated symptoms and their response to botulinum toxin therapy. J Neural Transm (Vienna). 2010;117(6):765-72. http://dx.doi. org/10.1007/s00702-010-0416-5. PMid:20467763.
7. Tan EK, Lum SY, Fook-Chong S, Chan LL, Gabriel C, Lim L. Behind the facial twitch: depressive symptoms in hemifacial spasm. Parkinsonism Relat Disord. 2005;11(4):241-5. http://dx.doi.org/10.1016/j. parkreldis.2004.12.003. PMid:15878585.
8. Abbruzzese G, Berardelli A, Defazio G. Hemifacial spasm. Handb Clin Neurol. 2011;100:675-80. doi: 10.1016/B978-0-444-52014-2.00048-3. PMID:21496615.
9. Ehni G, Woltman HW. Hemifacial spasm. Arch Neurol Psychiatry. 1945;53(3):205-11. http://dx.doi.org/10.1001/ archneurpsyc.1945.02300030042006.
10. Sprik C, Wirtschafter JD. Hemifacial spasm due to intracranial tumor. Ophthalmology. 1988;95(8):1042-5. http://dx.doi.org/10.1016/ S0161-6420(88)33044-7. PMid:3266003.
11. Kuroda T, Saito Y, Fujita K, et al. Efficacy of levetiracetam in primary hemifacial spasm. J Clin Neurosci. 2016;34:213-5. http:// dx.doi.org/10.1016/j.jocn.2016.05.025. PMid:27460515.
12. Jain S, Hasan S, Vyas N, Shah N, Dalal S. Pleomorphic adenoma of the parotid gland: report of a case with review of literature. Ethiop J Health Sci. 2015;25(2):189-94. http://dx.doi.org/10.4314/ejhs.v25i2.13. PMid:26124628.
13. Martin EJ, Carlson ML, Moore EJ, Jackson RS. Hemifacial spasm secondary to parotid pleomorphic adenoma with stylomastoid foramen extension. Otol Neurotol. 2017;38(1):129-32. http://dx.doi.org/10.1097/ MAO.0000000000001256. PMid:27755360.
14. Yang SY, Vásquez CM, CYSTICERCOSIS WORKING GROUP IN PERÚ. Hemifacial spasm secondary to arachnoiditis due to neurocysticercosis: clinical image. World Neurosurg. 2020;143:180-2. http://dx.doi.org/10.1016/j.wneu.2020.06.217. PMid:32645374.
15. Ruiz-Juretschke F, Vargas A, González-Rodrigalvarez R, Garcia-Leal R. Hemifacial spasm caused by a cerebellopontine angle arachnoid cyst. Case report and literature review. Neurocirugia (Astur). 2015;26(6):307- 10. http://dx.doi.org/10.1016/j.neucir.2015.05.001. PMid:26165486.
16. Wang L, Jiang M, Yin H, et al. Cavernous angioma of the cerebellopontine angle presenting as hemifacial spasm. Neurol India. 2018;66(6):1826-8. http://dx.doi.org/10.4103/0028-3886.246250. PMid:30504594.
17. Dudoit T, Balossier A, Reyes-Botero G, et al. Adult brainstem glioma presenting with isolated persistent hemifacial spasm or facial nerve palsy. Rev Neurol (Paris). 2021;177(10):1276-82. http://dx.doi. org/10.1016/j.neurol.2021.03.006. PMid:34272066.
18. Navarro-Olvera JL, Covaleda-Rodriguez JC, Diaz-Martinez JÂA, Aguado-Carrillo G, Carrillo-Ruiz JÂD, Velasco-Campos F. Hemifacial spasm associated with compression of the facial colliculus by a choroid plexus papilloma of the fourth ventricle. Stereotact Funct Neurosurg. 2020;1–5(3):145-9. http://dx.doi.org/10.1159/000507060. PMid:32316018.
19. Cai Y, Ge M, Qi X, Sun H, Zhang D. Ocular dyskinesia and hemifacial spasm secondary to fourth ventricular tumor: report of 4 cases and review of the literature. Pediatr Neurosurg. 2019;54(5):1-8. http:// dx.doi.org/10.1159/000501915. PMid:31437843.
20. Umezu H, Aiba T, Unakami M. Enterogenous cyst of the cerebellopontine angle cistern: case report. Neurosurgery. 1991;28(3):462- 5, discussion 465-6. http://dx.doi.org/10.1227/00006123-199103000- 00025. PMid:2011235.
21. Eynon-Lewis NJ, Kitchen N, Scaravilli F, Brookes GB. Neurenteric cyst of the cerebellopontine angle: case report. Neurosurgery. 1998;42(3):655-8. http://dx.doi.org/10.1097/00006123-199803000- 00040. PMid:9527002.
22. Ligas B, Khatri D, Higbie C, Wagner K, Langer D. A case report of Hemifacial spasms due to bony stenosis of the Internal auditory meatus: look beyond the loop. World Neurosurg. 2020;137:179-82. http://dx.doi.org/10.1016/j.wneu.2020.01.196.
23. Nagata S, Matsushima T, Fujii K, Fukui M, Kuromatsu C. Hemifacial spasm due to tumor, aneurysm, or arteriovenous malformation. Surg Neurol. 1992;38(3):204-9. http://dx.doi.org/10.1016/0090- 3019(92)90170-R.
24. Naraghi R, Tanrikulu L, Troescher-Weber R, et al. Classification of neurovascular compression in typical hemifacial spasm: three-dimensional visualization of the facial and the vestibulocochlear nerves. J Neurosurg. 2007;107(6):1154-63. http://dx.doi.org/10.3171/ JNS-07/12/1154. PMid:18077953.
25. Ehni G, Woltman HW. Hemifacial spasm. Arch Neurol Psychiatry. 1945;53(3):205-11. http://dx.doi.org/10.1001/ archneurpsyc.1945.02300030042006.
26. Hermier M. Imaging of hemifacial spasm. Neurochirurgie. 2018;64(2):117-23. http://dx.doi.org/10.1016/j.neuchi.2018.01.005. PMid:29705020.
27. Mercier P, Sindou M. The conflicting vessels in hemifacial spasm: literature review and anatomical-surgical implications. Neurochirurgie. 2018;64(2):94-100. http://dx.doi.org/10.1016/j.neuchi.2018.01.004. PMid:29680283.
28. Jannetta PJ, Kassam A, Reigosa RP. Hemifacial spasm. J Neurol Neurosurg Psychiatry. 1999;66(2):255-6. http://dx.doi.org/10.1136/ jnnp.66.2.255a. PMid:10071121.
1MD, MR, Medical Residency in Neurosurgery, Department of Neurosurgery, Neurological Institute of Curitiba - INC, Curitiba, PR, Brazil.
2MS, Medical student, Department of Medicine, University of the Region of Joinville - Univille, Joinville, SC, Brazil.
3MD Neurosurgery, Department of Neurosurgery, Neurological Institute of Curitiba - INC, Curitiba, PR, Brazil.
4MD, PhD, Neurosurgery, Department of Neurosurgery, Neurological Institute of Curitiba - INC, Curitiba, PR, Brazil.
Received July 28, 2023
Accepted Aug 01, 2023
